Movement disorders, dystonia and chorea: Viva

Branch 1: Naming and classifying the movement

A strong candidate names this dystonia and classifies it on the Albanese 2013 two axes. Dystonia is sustained or intermittent involuntary muscle contraction that causes twisting, repetitive movements, or abnormal postures. On axis I, the clinical characteristics, this is a childhood-onset, focal-to-generalising, action-induced lower-limb dystonia with a diurnal temporal pattern of evening worsening and morning improvement. On axis II, the aetiology, the diurnal pattern flags dopa-responsive dystonia, but the candidate keeps the inherited and acquired differentials open, including cerebral palsy, Wilson disease, and glutaric aciduria type 1, until the workup closes. The candidate also places the movement in the Sanger 2003 childhood hypertonia framework, which sorts hypertonia into spasticity, dystonia, and rigidity. ^[1][2]